Change is Underway

As the Biden administration continues to fill key staff positions and roll out new initiatives, there is a growing sense among family planning advocates that we are on the verge of some truly wonderful progress.

Budget Season Begins

As is typical during the first year of a presidential administration, the budget process is starting off a little later than normal. In mid-April, the Biden administration released a preview of its budget request for FY 2022. In it, the administration says it will be requesting $10 billion for global health—that’s an $800 million increase over the current funding level. The preview budget suggests that the bulk of this increase should be spent on global health security. The global health budget is part of an overall international affairs funding request of $63.5 billion—$6.8 billion more than the current level.

The more detailed budget proposal with individual program funding levels is expected in May, after the print deadline for this issue. Both the House and Senate will wait for this more detailed outline before releasing their own proposed numbers. Meanwhile, we continue to advocate with our allies on the Hill for robust funding for international family planning.

Helms Repeal Bill Reintroduced

On March 9, Rep. Jan Schakowsky (D-IL), joined by Reps. Barbara Lee (D-CA), Jackie Speier (D-CA), Ayanna Pressley (D-MA), Diana DeGette (D-CO), Norma Torres (D-CA), and freshman member Marilyn Strickland (D-WA), reintroduced the Abortion Is Health Care Everywhere Act (H.R. 1670). The bill would amend the Foreign Assistance Act to repeal the Helms Amendment and replace it with language explicitly stating that U.S. foreign assistance funds can be used to provide comprehensive reproductive health care, including abortion services.

Since 1973, the Helms Amendment has prohibited the use of U.S. foreign assistance funding for abortion “as a method of family planning.” The language has been interpreted as an outright ban on the use of such funds for abortion services under all circumstances, including in cases of rape and incest and when the life of the pregnant person is threatened by the pregnancy.

The Helms Amendment has been rightly criticized as imperialistic, hypocritical (in the United States, there are important exceptions to the ban on federal funding for abortion, whereas there are none with regard to U.S. foreign assistance), and dangerous to the lives of those who will seek unsafe abortions in the absence of access to safe abortion services.

The impact of repeal would be dramatic. The Guttmacher Institute, looking only at countries where abortion is legal in at least some circumstances and where the U.S. already supports family planning programs, found that if the Helms Amendment were repealed and U.S. funding helped support safe abortion, each year those countries would see:

• 19 million fewer unsafe abortions,
• 17,000 fewer maternal deaths,
• 98 percent fewer maternal deaths due to abortion, and
• 12 million fewer women who have abortion-related complications requiring medical treatment.

Because the Helms Amendment is part of permanent statute, congressional action is required to repeal it. The Abortion Is Health Care Everywhere Act, first introduced in the last (116th) Congress, is the only bill ever introduced to repeal Helms. In a statement on the newly reintroduced bill, Congresswoman Schakowsky said:

Making abortion legal isn’t the beginning of women having abortions. It’s the end of women dying from abortions. It means that women will have what I think is the fundamental choice that describes their freedom: the right to control the size of their families.

EACH Act Reintroduced

On March 25, Sen. Tammy Duckworth (D-IL) and Rep. Barbara Lee (D-CA) reintroduced the Equal Access to Abortion Coverage in Health Insurance Act of 2021 (The EACH Act S.1021/H.R.2234). The EACH Act would do away with the Hyde Amendment and guarantee abortion coverage to people who get their health insurance through the federal government. It would also forbid state and federal governments from prohibiting abortion coverage in private insurance plans.

First authored by Rep. Henry Hyde (R-IL) in 1976, the Hyde Amendment is not part of statutory law. Instead, it has been included as part of the congressional appropriations process every year since 1977. It forbids the use of federal dollars to pay for abortions, except in cases of rape, incest, and when the life of the pregnant person is threatened.

Initially, the Hyde Amendment was only applied to Medicaid, a joint state/federal health program for low-income people. Because the amendment restricts funding for the Department of Health and Human Services (HHS), it also impacts abortion funding under other programs, including Medicare, the Children’s Health Insurance Program, and the Indian Health Service. In the years since its introduction, similar language has made its way into other federal programs, including the military health insurance program, the federal employees insurance program, the Peace Corps, and even the Affordable Care Act (ACA).

Because contributions to Medicaid come from both states and the federal government, states can choose to more broadly cover abortions, as long as they use their own money. Currently, only 16 states do so. The District of Columbia has done so in the past, but because its budget is subject to congressional approval, its residents’ access is intermittent.

The Hyde Amendment is a significant equity issue: People enrolled in Medicaid are, by definition, low-income; they are more likely to be people of color; and they are more likely to experience an unintended pregnancy. Lack of Medicaid coverage for abortion services means patients must pay out-of-pocket for the procedure. Costs vary widely depending on location, length of pregnancy, and type of abortion chosen, but an uninsured patient can expect to spend at least $500—an enormous burden for someone already struggling financially.

Biden Moves to Undo Domestic Gag Rule

On April 14, HHS released a proposed new rule for Title X, the U.S. domestic family planning program for low-income individuals. The new rule would undo the onerous restrictions placed on the program under the Trump administration. That rule—dubbed the Domestic Gag Rule—which went into effect in 2019, has had devastating effects. An estimated 981 clinics left the program in 2019, slashing Title X’s capacity by half and jeopardizing care for 1.6 million patients. Six states (Hawaii, Maine, Oregon, Utah, Vermont, and Washington) were left with no remaining Title X-funded providers.

Because this is a regulatory change, rather than a legislative one, there is a defined process that must be followed. It will take, at a minimum, several months for the new regulation to take effect, and even longer for providers to rejoin the program.